Clinical Outcome after DMT Discontinuation

Clinical Outcome after DMT Discontinuation Background: Stable disease course may prompt consideration of disease-modifying treatment (DMT) discontinuation in relapsing-remitting multiple sclerosis (RRMS). Objective: To investigate the clinical outcome after DMT discontinuation and to identify predictive factors supporting decision-making. Methods: We included 221 RRMS patients, who discontinued DMT after à ¢Ã‚ ©Ã‚ ¾12months and had documented follow-up à ¢Ã‚ ©Ã‚ ¾2years after discontinuation. Hazard ratios (HRs) with 95% confidence intervals (CIs) regarding relapse and disability progression after DMT discontinuation were calculated from Cox regression models. Results: Age >45 years at discontinuation (HR=0.47, CI=0.23-0.95, p=0.038), absence of relapses for à ¢Ã‚ ©Ã‚ ¾4years on DMT before discontinuation (HR=0.29, CI=0.10-0.82, p=0.020) and absence of contrast enhancing lesions (HR=0.46, CI=0.28-0.78, p=0.004) were independent predictors of absence of relapse after discontinuation. Age >45years and absence of relapses à ¢Ã‚ ©Ã‚ ¾4years on DMT combined had an HR of 0.06 (CI=0.01-0.44, p45 years and longer disease duration were significantly associated with disability progression after discontinuation. Conclusion: While freedom from further disease activity is generally unpredictable, there is a subset of patients (age à ¢Ã‚ ©Ã‚ ¾45years, DMT intake à ¢Ã‚ ©Ã‚ ¾4years without evidence of clinical or radiological disease activity) having a high likelihood of remaining relapse-free after DMT discontinuation. However, close clinical monitoring for recurrent disease activity is mandatory after discontinuing treatment. MS is an autoimmune, demyelinating, inflammatory neurological disease that develops from a complex interplay of both genetic and environmental factors. The mechanism of demyelination in multiple sclerosis may be activation of myelin-reactive T cells in the periphery. T cells are activated following antigen presentation by antigen-presenting cells such as macrophages and microglia, or B cells. These T cells then express adhesion molecules, allowing their entry through the blood-brain barrier (BBB). These invasive perivascular T cells can secrete proinflammatory cytokines, including interferon gamma and tumor necrosis factor alpha which contribute to the inflammatory processes in the central nervous system. Furthermore, antibodies against myelin also may be generated in the periphery or intrathecally by activated B cells. Ongoing inflammation leads to epitope spread and recruitment of other inflammatory cells (ie, bystander activation). Activated microglia may release free radicals, ni tric oxide, and proteases that may contribute to tissue damage. In summary, MS has 3 characteristic features; Inflammation leading to the infiltration of Perivascular lymphocytes into the central nervous system, demyelination of neurons and the subsequent formation of Central Nervous System lesions (Plaques) The CNS lesions mainly affect the white matter and they are both disseminated in time (DIT) and in space (DIS). White matter help transmit information between regions of grey matter, where the processing occurs. Therefore symptoms of MS are highly dependent on the location of the lesion in the CNS. In 1996, 4 main types of MS were defined, be the National Multiple Sclerosis Society, according to the clinical course of the disorder; Relapsing Remitting Multiple Sclerosis (RRMS) Secondary Progressive Multiple Sclerosis (SPMS) Primary Progressive Multiple Sclerosis (PPMS) Progressive Relapsing Multiple Sclerosis (PRMS) The treatments for MS are split into 3 main types that target 3 different aspects of the disease, namely treatments for MS exacerbations/attacks, treatments for specific MS symptoms and treatments to prevent relapses and disease progression. The last group of treatments are the focus of this study. Despite having no cure for MS there are treatments that significantly reduce both the frequency and severity of relapses in some patients and slow the progress of neurological deficits in MS. These are called Disease Modifying Therapies(DMT). The goal of these therapies is to decrease the extent of damage and scarring to the myelin sheath associated with relapse and in doing so prevent the progression of disease and are especially useful for patients with RRMS. This study focuses on the first line injectable treatments, Beta interferons and Galatiramer Acetate. Interferon beta balances the expression of pro- and anti-inflammatory agents in the brain, and reduces the number of inflammatory cells that cross the blood brain barrier therefore it also improves nerve regeneration. Galatiramer acetate resemles myelin basic protein, thus acting as a decoy for the immune system to target and in doing so protects the myelin surrounding axons in the CNS. Despite their usefulness, DMTs are not suitable for all MS patients due to their side effects. Thus they are only prescribed to patients with RRMS or SPMS who meet certain criteria. Specifically, Beta interferon give rise to headache, chills, fever and pain and redness at injection site while, Glatiramer acetate results in redness and hardening of skin at injection site and rarely palpitations or flushing after injection. Due to these many side effects many patients who experience few or no relapses over a long period of time and have a stable disease course frequently enquire if they can discontinue their DMT without the risk of relapses coming back and the disease and disability progression of MS getting worse. Therefore this study was designed as an observational cohort study that aimed to understand the effects of discontinuation of DMTs on the primary and secondary endpoints; occurrences of relapses after discontinuation of DMTs and disability progression after discontinuation o f DMTs respectively and thus and thus provide predictive criteria that may help clinicians and patients make the decision to discontinue DMTs 0-What is the research question? What is the Primary Outcome? The primary outcome of the study is understanding the effects of discontinuation of DMTs on the primary and secondary endpoints; occurrences of relapses after discontinuation of DMTs and disability progression after discontinuation of DMTs respectively. What are the Secondary outcomes? The secondary outcome of the study was to use and analyse the findings derived from outcome one to discern any factors that would minimize the adverse effect of discontinuation of DMTs and thus provide predictive criteria that may help clinicians and patients make the decision to discontinue DMTs. Is the research question clear and properly addressed? Yes it is as the paper aims to answer the question of whether discontinuation of DMTs in patients with RRMS would largely affect the clinical outcomes in any adverse manner and through that discern any predictive factors that may help clinicians and patients make the decision to discontinue DMTs. 1 Are the methods valid? 1a Details of Assignment of patients Are the inclusion and exclusion criteria clear? Patients for the study were selected form the Innsbruck MS database (IMSD), which contained 1708 patients, through a careful screening process. The exclusion criteria included patients with PPMS or SPMS, patients who received DMT for less than 12 months, patients who discontinued DMT for less than 6 months, patients with less than 2 years of follow up available and patients with a documented pregnancy during the follow-up period. After all these exclusion criteria were applied, the patients who still remained were included in the study, thus 221 patients were included in the study Was randomisation done properly? Randomising before the aforementioned selection process selection process could have influenced the decisions about eligibility and introduced a source of bias and if a large number of randomly selected patients turned out to be ineligible it would have led to a very small sample size and thus significantly lowered the power of the study. Randomisation after the aforementioned selection process was not carried out for this study since this study was designed as an observational cohort study and all the patients in the inclusion list were discontinuing DMTs due to one of 3 reasons indicated in the study; namely adverse events, patients decision (including desire of pregnancy) or (3) stable disease course (subjectively defined by the treating physician and/or patient). Randomisation would have been more essential in a case control study that compared the effects of DMT discontinuation in one group against a matched control group of MS patients who continued taking DMTs. This is explored further in the future works section as a possible continuation from and improvement on this study. Was assignment concealed from Drs? (at the assignment stage) Due to the fact that the study was designed as an observational cohort study and the highly specific inclusion criteria the assignment was not concealed from Drs. Was the sample size big enough? The sample size for this study comprised all the 221 patients in the inclusion list. This was a relatively small sample size for a cohort study. However considering the large numbers of exclusion criteria and the fact that the study focused on a specific subset of MS patients; namely patients with RRMS who were being treated with either Interferon Beta or Galactemer Acetate for more than 12 months, who are not pregnant and had a greater than 2 year follow up, the study does have a high predictive power. For this subset of MS patients the studys results provide a good predictive power yet this does not extend to any MS patients outside this subset. The usefulness of this study is further undermined by the fact that just a month before this was published a similar study was done by the MSBase Registry with a case control design looking at 426 DMT stoppers, which is almost double the sample size in this study thus providing a far larger power. 1b Accounting for patients entered into the trial How complete was the follow up? The median follow up period was 3.8 years with maximum follow up period being 26.9 years and minimum follow up being 2 years. How were patients lost to follow up dealt with? As part of the exclusion criteria, patients who were lost to follow up either due to discontinuation of DMT for less than 6 months or because patients had less than 2 years of follow up available or because patients had a documented pregnancy during the follow-up period were excluded from the study and thus also excluded from the calculation on the results of the study. How were patients not receiving assigned treatment (non-compliers) dealt with ? During the follow up period 69 of the 221 patients restarted DMTs after the 6 month cutoff imposed in the exclusion criteria. If DMT was restarted during this observation period, the primary endpoint was considered to be reached at the time point of reinitiation of DMT and thus the patients were still used for calculating the final results. Is there likely to be residual bias because of any of the above? Since data for the study was collected retrospectively at the first visit this does introduce a potential source of bias due to the lack of data completeness for some variables. Moreover, since this study was not conducted in a case control manner there is a possibility that important unmeasured variables could have had a confounding effect on the observed results. However, since data was collected prospectively from then on it serves to minimize any sources of residual bias by attempting to correct for any confounders. The fact that all the patients were selected from the Innsbruck MS database, which mainly represents the demographics of western Austria and its geographical catchment areas and the fact that there was no randomization carried out also introduces a potential source of selection bias and restricts the predictive power and usefulness of this study 1c Blinding How far was it carried out for patients, doctors, other study personnel? In this study blinding was not carried out as all eligible patients in the inclusion list underwent the same intervention which was the discontinuation of DMT. Furthermore, the fact that this study was designed as an observational cohort study meant that blinding was not entirely necessary 1e Apart from experimental intervention were the groups treated equally? Apart from the discontinuation of DMTs all the other decisions about the patients care was left up to their respective doctors and any MS specific interventions or healthcare concerns, such as pregnancies, were noted in the regular follow ups. 2. What are the results? 2a Were outcomes measured in a standard valid reliable way ? The primary and secondary endpoints of this study were the occurrences of relapses after discontinuation of DMTs and disability progression after discontinuation of DMTs respectively. A relapse was defined as patient-reported symptoms or objectively observed signs typical of an acute central nervous system (CNS) inflammatory demyelinating event, current or prior to the visit, with duration of at least 24 hours in the absence of fever or infection, separated from the last relapse by at least 30 days.27 Disability progression was defined as a confirmed EDSS increase in 0.5 sustained for 6months. MRI was only included in analysis if performed within a maximum of 6months prior to discontinuation of DMT (MRI at discontinuation) and if there was another MRI available for comparison performed 1-24months prior to MRI at discontinuation (MRI before discontinuation). MRI parameters obtained were increase in T2 lesion load and presence of gadolinium-enhancing lesions. Increase in T2 lesion load was defined as à ¢Ã‚ ©Ã‚ ¾1 either new or size-enlarged T2 lesion in MRI at discontinuation compared to MRI before discontinuation. 2b Are results comparable at different sites ? These crietria for measurement and reporting of data helped standardize the measurement of the outcomes among the multiple study sites. 2c How large was the treatment effect ? Relapses Primary Outcome: Bivariate testing showed a correlation between absence of relapses after DMT discontinuation and younger age at discontinuation (r=à ¢Ã‹â€ Ã¢â‚¬â„¢0.352, p There was no association with disease duration (p=0.327). Secondary Outcome: ROC analyses indicated best possible cutoff values of 45 years for age at discontinuation (sensitivity: 65%, specificity: 85%) and 4 years for duration of DMT intake without a relapse (sensitivity: 60%, specificity: 81%) 14/56 (25%) patients aged à ¢Ã‚ ©Ã‚ ¾45 years at discontinuation suffered a relapse after discontinuation of DMT compared to 84/165 (50.9%) of patients Age >45 years and absence of gadolinium-enhancing lesion before discontinuation of DMT were found to be independent predictors of absence of relapse after discontinuation of DMT, each about cutting the risk for future relapse in half. Absence of relapses for a period of 4 years or longer on DMT reduced the risk of future relapse to under a third. Sex and EDSS at discontinuation did not have any significant impact. Patients aged >45 years with absence of relapses for a period of 4years on DMT had a cumulative hazard ratio (HR) of 0.06 (CI=0.01-0.44, p Disability Progression Primary Outcome: Bivariate analysis exhibited a statistically significant correlation between disability progression and EDSS at discontinuation (r = 0.212, p = 0.002), disease duration (r = 0.172, p = 0.004) and age at discontinuation (r = 0.123, p = 0.042), but not for duration of DMT, occurrence of relapses on DMT and presence of gadolinium-enhancing lesions. Secondary Outcome: After inclusion of these variables in a multivariate cox regression model, higher EDSS at discontinuation, age >45 years at discontinuation and longer disease duration were the only significant independent predictors of disability progression after discontinuation. Patients aged à ¢Ã‚ ©Ã‚ ¾45 years with absence of relapses for a period of 4 years on DMT did not have a significant reduction in their risk for disability progression How precisely is it measured (95% CIs)? Categorical variables were expressed in frequencies and percentages, parametric continuous variables as mean and 95% confidence intervals (95% CIs) and nonparametric variables as median and range. Comparisons regarding primary and secondary endpoints were made by bivariate correlations (Kendalls tau) and Fishers exact or chi-square tests as appropriate. Receiver operating characteristic (ROC) analyses were conducted to define the best possible cut-off values of continuous variables for prediction of the primary endpoint. Survival analyses were performed using cox regression models for comparison of prognostic factors over time and assessment of possible confounders. A two-tailed p-value 2d What is the clinical significance of the results and how precisely is it measured?  Ãƒâ€šÃ‚   The secondary outcome of this study has a higher clinical significance than the primary outcome. The results show that 3.   Are the results applicable to your patient(s)? 3a Are your patients similar to the study patients? 3b Were all the outcomes that are of interest to your patients considered in the trial? 3c Are the benefits worth the potential harms and costs? In the future a different study design can be used to tackle the same research question. A further case control study, like the one done by the MSBase Registry, that compared the effects of DMT discontinuation in one group against a matched control group of MS patients who continued taking DMTs could be carried out to minimize any effects of confounders and biases that may have affected the results of the cohort study. A future cohort study could include a larger sample size that would be more representative of a larger proportion of the patients with MS. Choosing from a more diverse patient demographic would also provide a greater amount of predictive power over the cultural diverse population of MS patients that are found in the local London boroughs. A similar study could be repeated with a fully prospective design so as to eliminate any selection biases that may have arisen due the retrospective nature of initial data collection. Furthermore, the retrospective nature of this study also led to only 168 of the 221 selected patients having MRI data available within 6 months before discontinuation of DMT thus reducing the predictive and representative power of many conclusions derived from MRI comparison data. Thus, more detailed and complete analysis using MRI data could have been obtained if the study was designed to be entirely prospectively conducted without the retrospective data collection. Focus on newer DMTs Since this study only focused on the first line DMTs which only account for a portion of the RRMS patients receiving DMT future work can focus on the other available newer DMTs. The data on the post-injectable DMT disease course may not be generalisable to the newer agents thus it is essential to conduct DMT discontinuation studies on other oral or intravenous DMTs available to patients which have a larger range of side effects and arguably have more severe side effects. Furthermore even though this study provides some predictive criteria that may help clinicians and patients make the decision to discontinue DMTs, To definitively answer the question about safety of DMT discontinuation in this patient subset, a randomised trial is required. The first randomised DMT discontinuation trial in MS is was scheduled to start recruitment in 2016 and its findings should provide more conclusive evidence about the safety and viability of DMT discontinuation in the patient subsets identified in this study both in terms of number of relapses and disability progression.

The Anglo-saxon Literature Essay -- essays research papers

In the Anglo-Saxon literature, the scop has a privilege of retaining history, culture and social values of that society. In many cases the scop exercises the power to create stories which reflect the values of that society. The Rood in the  ¡Ã‚ °The Dream of the Rood ¡Ã‚ ± also tells a story of which affects its society and people. The existence of this witness that reports the suffering and the glorification of Christ proves necessary for the people to believe. The Rood becomes a hero that preserves an event that proves crucial to the society. As the Rood observes the suffering of Christ, it also shares with him the pains of crucifixion. In other words, the Rood takes part in Christ ¡Ã‚ ¯s crucifixion which pertains to the salvation of the souls. Although the Rood declares its god-like qualities along with Christ, there ¡Ã‚ ¯s a distinction between Christ and the Rood. Therefore, the Rood appears as a metonymic figure which represents the Christ ¡Ã‚ ¯s suffering but it doe s not represent Christ. In fact, the Rood assumes the role of Christ as it demands people to worship it. In this poem, the Rood appears as an Anglo-Saxon hero. However, the Rood fails to share the Christian beliefs when it declares the entity of God along with Christ. Although Christ and the Rood shared the  ¡Ã‚ °innocent ¡Ã‚ ±Ã‚ ¡Ã‚ ¯ suffering together, this does not provide an adequate explanation for the Rood to become a replacement of Christ. Indeed, the Rood appears as a hero in the Anglo-Saxon society for it reflects the values of many figures that suffer with their Lord. The Rood shares the suffering endured by Christ. It does not regret its pains but sympathizes with Christ as it brings unto itself the hostilities directed at Christ. Thus, it states,  ¡Ã‚ °[how] they mocked at us both ¡Ã‚ ±( ¡Ã‚ °The Rood ¡Ã‚ ±, 51). Suffering with the members of the community proves important to a hero in the Anglo-Saxon literature. In  ¡Ã‚ °The Battle of Maldon, ¡Ã‚ ± a band of warriors fight to save their community, more specifically, fight to  ¡Ã‚ °serve the Earl ¡Ã‚ ±(The Battle of Maldon, 11). Bryhtnoth is the Earl of these brave warriors who fight unto death in order to carry out their duty. This duty indicates that one does not desert a battleground and retreat in order to save one ¡Ã‚ ¯s life. Therefore, the heroes share the battlefield alongside their lord and fight until they win or die. Like these heroes of the Maldon, the Rood remains steadfast in sh... ...st did not have in mind for the people to worship a tree.  ¡Ã‚ °The Rood ¡Ã‚ ± states its separate entity from Christ.  ¡Ã‚ °The Tree of Victory ¡Ã‚ ± becomes itself a figure that must be worshipped by its people. In fact, the Anglo-Saxon society views its heroes as gods through the scops of the society. In Anglo-Saxon literature, scops acquire the power to influence and preserve their tradition, history and culture. The scops glorify the heroes of their times according to their deeds which uphold the values of that society. In addition, the scops give the heroes of their society power to be immortal. They honor their heroes as gods and inevitably honor the values that these heroes uphold. The Rood is one of the Anglo-Saxon heroes that represents the importance of sacrifice of enduring crucial suffering in order to benefit its society. Regardless of its former status, the Rood ¡Ã‚ ¯s deeds reinforce the values of the Anglo-Saxon sense of loyalty that makes them fearless in the face of wierd. In the face of the approaching death, these heroes are portrayed as honoring their community more than their lives. Thus, by remembering and worshipping these heroes, the Anglo-Saxons tend to honor their society.

Butcher Boys by Jane Alexander Essay

Butcher Boys is a work of art created by Jane Alexander in 1985-86. Jane Alexander is a caucasian female who was born in Johannesburg South Africa in 1959, and grew up in South Africa during the tumultuous political and cultural atmosphere of apartheid and the fight for civil rights. This location, or more specifically the cultural, social and political aspects of this location, affected Alexander’s work, Butcher Boys. The artist states, â€Å"my work has been a response to the social environment I find myself in. Apartheid happened to be the important political condition at a certain time, and it still impacts my perception of social environments now, here or abroad†. (Dent). Alexander still resides in South Africa and currently teaches at the Michaelis School of Fine Arts in Cape Town (Bick 30). Butcher Boys is a work consisting of three plaster-cast, life-size naked figures that embody both human and inhuman characteristics. The human characteristics include arms, legs, hands, feet and torsos that are combined with monster like heads with decaying horns, dark eyes, cleaved backs, sutured chests, ear holes and lacking mouths. The genitalia of the figures appear to be covered by codpieces. The three figures are seated on a bench in a mundane position that could be seen in a â€Å"doctor’s office waiting room† or similar to â€Å"athletes on the bench.† (Klassmeyer). This exhibit is not separated from the audience by rails or boundaries, but is on an equal level to viewers, and therefore viewers are able to see the art piece from all angles. The artist used oil paints to create the darkness of the defects of the figures making them seem more realistic. This artwork was created by Alexander while she was completing a masters degree at the University  of Witwatersrand. She may have chosen the media of plaster to create these figures due to the message she intended to portray. The possible message, which will be discussed in detail later, is controversial and addresses the  large topic of apartheid. Perhaps the artist wanted to make a life-sized exhibit to make an impression and better communicate this important message. This exhibit is not just large but the humanoid figures are created to scale of the human form which makes the message more intimate and relatable to the general audience. Another reason why Alexander may have chosen plaster for this art piece, is that plaster is inexpensive and easily accessible. For a student, and I speak from experience, these are important considerations when choosing a medium to utilize. Therefore, plaster allowed Alexander to make the statement she intended within her constraints as a stude nt. In A History of Art in Africa, Suzanne Blier describes various categories that can applied to African art. Several of these categories apply to Jane Alexander’s piece Butcher Boys. Alexander utilizes innovation of form by adding innovations to the human figure to communicate her message. This symbolizes the inhuman characteristics of the culture of apartheid. This technique of creating human forms with inhuman additions has a realistic and yet surreal effect on the viewer. Visual abstraction is shown in this artwork by the deviation of the figures from the classic human form. Although the figures are in a very unremarkable position, they have cleaved backs, horns, ear holes and other inhuman attributes. Without the addition of these abstract characteristics, these figures would appear to be ordinary humans, and the thought provoking connotations of the piece would be lost. The figures in the art piece are human like and represent human society. This shows humanism/ anthropomorphism. There are also three figures arranged together in this piece making this display an ensemble. The meaning of Butcher Boys is very intellectually complex, and can be interpreted in a variety of ways. Therefore the piece shows a multiplicity of meaning. The various interpretations of this piece will be discussed at a later point in this essay. The categories that do not apply to Alexander’s piece include parallel  asymmetries and performance. The cultural, political, and social circumstances that existed in South Africa during the life of Jane Alexander greatly impacted her art, and specifically the piece Butcher Boys. To appreciate the meaning of this piece  it is necessary to understand the history of South Africa, the origin of the artist. Similar to other African countries, South Africa was colonized by Europeans including Dutch and later British immigrants. The discovery of gold and diamonds in the mid 1800s brought an increase in attention to South Africa and therefore, an increase in immigration from European countries. The Zulu, an empire of the indigenous African population, was defeated by the British and the Dutch in 1879. These white immigrants over time established control of the indigenous populations by creating several laws and limitations. The Native’s Land Act of 1913 assigned 87% of the land in South Africa to the white population and 13% to blacks. The Mines and Works Act of 1911 assigned menial and manual labor to blacks and skilled labor to whites. During this time the indigenous population was denied many rights including the right to vote. In 1948, apartheid, a policy of racial segregation, was put into place by the ruling white population. This significantly increased the racial issues in South Africa. In the 1960s and 1970s South Africa encountered upheaval including several strikes and uprisings which result ed in many deaths. After this time South Africa experienced a continuous struggle between the black and white populations as the indigenous people fought for their civil rights, similar to what was experienced in the United States during this time. During this time of racial turbulence, Jane Alexander created the piece Butcher Boys in 1985-86. This cultural, social and political framework had a distinct impact that is communicated in the meaning of this piece. As an artist, Jane Alexander is generally silent as to her intended meaning of her pieces ArtThrob). Therefore, the meaning of Butcher Boys is open to interpretation and there are a variety of perceptions of this piece. One possible intention of this piece is to create emotions within the viewers related to the horrors that took place during the apartheid era in South Africa. The figures in the artwork may represent the  perpetrators of apartheid. The casualness of the appearance of the models in relation to the inhuman characteristics of each may communicate the good and evil within the white population involved in these atrocities. This may show the revulsion that Alexander felt toward the white population while living in South Africa during apartheid. In contrast, these figures can also be  perceived as representations of the black population. They show â€Å"dehumanized victims of apartheid’s crimes against humanity† (Bick 33) by the additions of horns, cleaved backs, and other inhuman attributes on the otherwise normal human form. It can be argued that the evil vs good theme displayed in this artwork portray the good and evil present in all of us. These sculptures have no genitalia or specific skin color and are therefore representations of humanity in general, and all viewers can relate the forms to themselves. This interpretation is intensified because the figures are life-sized and are not separated from the audience allowing them to become more intimate with the art piece. The human features of the sculptures cause viewers to relate personally to the figures, and ponder if the inhuman att ributes represent the evil inside themselves. Another interesting issue regarding the perception of Jane Alexander’s Butcher Boys occurred in February 2012. At this time, the South African band Die Antwoord’s lead singer Ninja dressed as a character resembling a figure in Butcher Boys in a teaser trailer for their album Tension. Die Antwoord speaks to the post-apartheid generation of the white population who is now experiencing a changing identity as the political and social entities in South Africa stabilize after a tumultuous past. Die Antwoord participates in â€Å"selecting, editing, and borrowing from available cultural resources to construct and perform a new white identity† (English). Jane Alexander communicated with the band after this release objecting to the band’s appropriation of the imagery of her piece. The band immediately removed the video and the lead singer responded that they used the imagery because Butcher Boys was one of the few South African art pieces that they were proud of. R eactions to this occurrence in South Africa have been mixed. Butcher Boys by Jane Alexander was chosen for this essay because it was previously introduced to the class and the image was found to be both visually and conceptually stimulating. After reading the article Horror Histories: Apartheid and the Abject Body in the Work of Jane Alexander, the historical significance of this piece made it even more intriguing. Butcher Boys became even more compelling after research showed that this specific art work, as well as its history, impacted the band Die Antwoord, which is a  band I appreciate. This piece is relatable to me personally because it shares many qualities of my own work which utilize the human form with alterations. I find the work of Jane Alexander to be inspirational and will draw from this experience in my future endeavors as an artist. Bibliography Being Human. Durham University. N.p., 3 Mar. 2009. Web. . Bick, Tenley. â€Å"Horror Histories: Apartheid and the Abject Body in the Work of Jane Alexander.† African Arts (2010): 30-41. Print. Dent, Lisa. â€Å"Global Context: Q+A with Jane Alexander.† Art in America. Cynthia Zabel, 6 Aug. 2012. Web. 30 Nov. 2013. . English, Chris. â€Å"Die Antwoord and Appropriation.† YouTube. YouTube, 06Dec. 2012. Web. 30 Nov. 2013. . â€Å"Jane Alexander.† ArtThrob. N.p., July 1999. Web. 30 Nov. 2013. . â€Å"Jane Alexander | South African History Online.† South African History. N.p.,15 Apr. 2009. Web. 30 Nov. 2013. . Jimenez, Dan’etta. â€Å"Jane Alexander: Surveys (from the Cape of Good Hope).† (2013): n. pag. Rpt. in Museum of African Art New York. N.p.: n.p., n.d. Print. Klassmeyer, Kelly. â€Å"Jane Alexander and the Dangers of Success.† Houston Press. N.p., 19 Sept. 2012. Web. 30 Nov. 2013. . Visonà  , Monica Blackmun. A History of Art in Africa. New Jersey: Pearson Prentice Hall, 2001. Print.

Weber and Religion The Prophet Motive Essay - 879 Words

Weber and Religion: The Prophet Motive Weber was concerned to demonstrate, contrary to Marxs thought, that culture was not reducible to the economic aspect of a society. Weber insisted that culture was to be considered as an autonomous value-sphere of any society. We might define such a value-sphere as; ..a distinct realm of activity which has its own inherent dignity and in which certain values, norms, obligations are inherent. (Brubaker:1983) Not only is this value-sphere of culture autonomous but, for Weber, it has the ability to construct forms of economic activity! For Weber, culture is seen as an agent in the production and maintenance of social relations. For†¦show more content†¦It is in this sense that we must understand charisma to be based upon a set of social relationships. Relationships of authority and legitimacy. Finally, charismatic authority arises in periods of social unrest and change and thus depends not only on the existence of this `exceptional individual but a social context which produces large numbers of individuals who are `disenchanted with the present social institutions. Charisma, is in Webers view ` a great revolutionary force for social change. Charismatic movements always seek to dismantle or overthrow existing/traditional forms of authority and power. Finally, Weber suggests charismatic authority as inherently unstable since it is usually based upon a `personality cult of the leader. When the leader dies then the movement will `die with him/her or ossify and institutionalise itself into what Weber refers to as `the charisma of office: bureaucracy! Look at Fig. 1, (at the bottom of page 2 of this document) which I have taken and adapted from Bryan Turners book. To understand the historical process we will need to begin with the `magician and move `clockwise towards `secular m an. We begin with the earliest form of society. Hunter-gatherer societies which were organised on the basis of kinship and lived in collectives of clans or tribes. The belief-systems of these peoples were, says Weber, based upon magic. Thus the magician (orShow MoreRelatedThe Protestant Ethic And Spirit Of Capitalism1828 Words   |  8 PagesSpring 2017 Prof. Delia TERM PAPER Sociology 101 â€Å"The Protestant Ethic and Spirit of Capitalism† Max Weber (1864-1920) considered seriously about the emerging dilemmas from the socio cultural and political state of affairs in Germany and criticised purely the historical materialistic concept of explanations. 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Their motives and intentions were various, but the overall effect of their efforts was to create a new and secular basis for capitalist cultural hegemony. 7I use the term hegemony reluctantly but unavoidably, because it suggests an illuminating perspective oilRead MoreOrganisational Theory230255 Words   |  922 Pagesintellectual and creative movement concerned with . The historical roots of modernist organization theory 59 a new understanding of humanity. It asserts that human beings can be free from the authority of the irrational power of monarchies and religion. We can use our powers of reason to obtain a true understanding of ourselves and society, and through science, the world of nature. The ideal of Enlightenment science is to use sensory observation – see, touch, taste, hear, smell – to capture theRead MoreLibrary Management204752 Words   |  820 Pagesshould: 24    Introduction Figure 2.2—Major Schools Contained in the Classical Perspective on Management Classical Schools of Management Scientific Management Frederick W. Taylor The Gilbreths Henry Gantt Bureaucratic Organizations Max Weber Administrative Principles Henri Fayol †¢ Develop a series of rules and routines to help workers in their daily work. †¢ Replace the rule-of-thumb method by finding the most efficient way. †¢ Select scientifically, and then train, teach, and develop